Tendinitis vs Tendinosis
Is this pain Tendinitis?
Tendinitis vs Tendinosis
Not all painful tendons are the same! Some tendons bear heavy load like the Achilles tendon while others are more delicate, assisting with fine movements of the toes.
Since not all tendons are the same, not all tendon should be treated the same. Your treatment plan may differ based on which condition you are experiencing.
What Is Tendinitis?
Tendinitis is inflammation of a tendon. Inflammation is your bodies response to injury. Tendinitis is usually triggered by repetitive motion or stress causing micro-tears of the tendon. Tendinitis can also be caused from a direct injury to the tendon or from heavy load. Continued or excessive use of an inflamed tendon can cause further inflammation to the tendon leading to more pain and damage.
Examples of activities that can lead to tendinitis in the foot/ankle include:
Walking barefoot, sandals/flipflops, wearing poorly fitted shoes.
Driving, walking, running, hiking, dancing, sporting activities
Inadequate stretching/warm up
Jumping, falling, rolling ankle/sprain.
Acquired flatfoot or congenital flatfoot deformities
How Is Tendinitis Treated?
Early stages of tendinitis treatment may include the following:
1.) Anti-inflammatories: NSAIDS (non-steroidal anti- inflammatories) live ibuprofen or naproxen. You may be prescribed additional medications to help with
inflammation and/or pain. These medications are designed to reduce the swelling in and around the tendon by reducing the inflammatory response of your body.
2.) Ice: Ice massage or ice bath 15-20 minutes several times daily.
3.) Rest: This may include immobilization, taping, padding, reducing the impact and/or repetition of activity, or even completely keeping weight off of the foot as instructed by your physician.
4.) Compression: A compression wrap, compression sleeve, compression stocking, or ace bandage can help reduce swelling in and around the tendon improving normal architecture to expedite proper healing of the tendon.
5.) Physical therapy: Therapy may be recommended to assist with your return to activity to help prevent re-injury or to assist with tendon healing.
Recommendations to prevent re-injury:
1.) Physical therapy and exercise to improve tendon strength, motion.
2.) Custom vs. over-the-counter orthotics may be recommended to improve stability to prevent re-injury.
3.) Occasionally surgical intervention may be discussed or recommended based on the severity of the tendon injury or issue causing the continued tendon injury.
What Is Tendinosis?
Tendinosis is chronic degeneration of tendon. This type of damage is caused by long term (chronic) tendon injury that has not properly healed. Immature connective tissue (Type III collagen) can invade an injured tendon causing irregularity and increased thickness in the native tendon. This can create weakness in the tendon by disrupting healthy, mature type I collagen fibers eventually leading to increased swelling, pain, or even tendon rupture.
How Is Tendinosis Treated?
Early treatments of tendinosis may include:
1.) Immobilization: This may include casting, taping, padding, heel lifts, reducing the impact and/or repetition of activity, or even completely keeping weight off of the foot as instructed by your physician.
2.) Ice: Ice massage or ice bath 15-20 minutes several times daily.
3.) Physical therapy: Therapy is designed to help your body repair and replace immature scar tissue in the diseased tendon with health mature tendon, reduce pain, and aid in return to activity.
4.) Stretching: You will be directed by your treating physician and/pr physical therapist on appropriate stretches to help improve tendon healing.
5.) Massage: Ice massage or manual massage can help break down immature scar tissue and assist with correct tendon healing.
Later treatments of tendinosis may also include:
1.) Weight training: Under the direction of your physician and/or physical therapist you may be directed on appropriate strengthening of tendon/muscle to assist with tendon healing, recovery, and to minimize risk of re-injury.
2.) Improve stability: Custom vs. over-the-counter orthotics may be recommended to improve stability if a tendon is predisposed to re-injury.
3.) PRP injection: Platelet Rich Plasma Injection therapy helps guide your bodies own repair process using specific proteins in your own blood. Platelet rich plasma is injected into the site of damage, providing growth factors and proteins to stimulate repair. This procedure
can be done in the office. This option is often recommended to avoid the need for surgical intervention.
4.) Surgery: If all nonsurgical options have been exhausted and your tendon injury is still preventing you from performing your normal activities, surgery may be considered. Additional imaging (MRI/Ultrasound) may also be order to guide you and your physician in choosing appropriate interventions throughout your treatment plan.
5.) Nutrition: Change to your diet may improve collagen production and improved tendon health. Nutrients linked to tendon health include vitamin C, manganese, zinc, vitamin B6, and vitamin E.
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